Auditory Electrophysiological Assessment of Hearing Function in Infants and Children with Esophageal Atresia: A Cross-sectional Study

Abstract

Background: Esophageal atresia (EA) is a congenital malformation occurring in approximately 1 in 4,000 births, with an unknown etiology. Some studies have reported an association between EA, cleft palate, and conductive hearing loss. This study investigates the potential involvement of the middle ear and auditory dysfunction in infants and children with EA (ages 0 - 15 years) using audiological assessments, particularly distortion product otoacoustic emissions (DPOAE) and auditory brainstem response (ABR) tests. Objectives: This study aims to assess the prevalence and characteristics of auditory dysfunction in infants and children with EA (ages 0 - 15 years) through electrophysiological tests (ABR and DPOAE), identifying potential correlations between EA and hearing impairments. Methods: This study was designed as a retrospective analysis of the medical records of 150 infants and children diagnosed with EA who were referred to Mofid Hospital in Tehran between 2018 and 2023. Auditory function was evaluated using ABR and DPOAE tests. Data on patient demographics, clinical history, and auditory test results were collected and statistically analyzed to determine the prevalence and patterns of hearing impairment in this population. Results: The results indicated a significant difference in the ABR test between the test group (n = 150) and the control group (n = 150), with a higher prevalence of conductive hearing loss in the test group (62 out of 150 cases; 41.3%, P ≤ 0.01, independent t-test). Additionally, 40% (60 out of 150) of children with EA had cleft palate lesions, which were strongly associated with conductive hearing loss (chi-square test, P < 0.05). Tympanometry results showed that 41 cases (27.3%) had type B curves, and 21 cases (14%) had type C curves, indicating middle ear dysfunction. Acoustic reflex testing revealed that all 41 cases with type B tympanograms had absent reflexes, while in the 21 cases with type C tympanograms, reflexes were either absent or elevated depending on the severity of negative middle ear pressure. Conclusions: The study findings indicate a significant prevalence of conductive hearing loss in children with EA, particularly among those with cleft palate. Middle ear dysfunction, as evidenced by abnormal tympanometry and absent acoustic reflexes, suggests that structural and physiological factors associated with EA contribute to auditory impairment. These results highlight the need for routine audiological screening in children with EA to facilitate early intervention and improve long-term auditory outcomes.